14979 POST THIS.CARD NEAR FRONT OF BUILDINGPERMIT NUn,BeR
CITY OF CUPERTINO
INSPECTION DIVISION 49 "
JOB INSPECTION RECORD
_ PERMIT EXPIRATION
JOB,ADDRESS-ss�// .z �`-"�/ /Q�R/�S ,t/�•I\LIIN,IIT#- LOT# / PERMIT EXPIRES IF WORK
OWNER 1 w pJfOU� CONTRACTOR C '/1`SC`C jQp((/� IS NOT STARTED WITHIN
INSPECTI N DATE INSPECTOR INSP CTION RECORD 180 DAYS OF PERMIT ISSU-
ANCE OR 180 DAYS FROM
FOUNDATION 7- - NOTE: LAST CALLED INSPECTION.
' UFER '�-IIS ALL GRADING AND DRAINAGE SHALL BE INSTALLED '
PREGUNITE ' TO COMPLY WITH.THE APPROVED PLANS AND CITY OF PERMIT VALIDATION
CUPERTINO STANDARDS. I
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - �'J % .,a,,�;✓
UNDERGROUN /SLAB
PLUMBING � � � � � e�
ELECTRICAL - - ISSUH NCEDATL
MECHANICAL - - LUG ELECT. I PLG. NIECR, .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED - w, '1 ILDING PERMIT
WOOD FLOOR v
1` INFORMATION
- � .�� py,�p TON IPT.
PLUMBING
MECHANICAL �� Df C1Y5 DOO
ELECTRICAL PERUll TO
FRAMING - ,
INSULATION STORIES TYPE CONST+
2 Uff
OCC.GROUP RES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED R-3 I
50,,, FLOOR ARIA TOTAL ACHI:ARE
-
ROOF NOTE:NO FINAL INSP.SHALL BE MADE BEFORE '}
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 2445- j
BUILDING USE
ROOF SHEATHING IS IND CON PB Om.,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASOSSORSPARCEL NO ❑
. ROUGH SAN.H 5-a -
PLUMBING ELECT.ENERGY
TRACT NU, - PARCELNO
TUBS 8 SHOWER PAN PLUMBING ENERGY `r 8067
MECHANICAL MECH.ENERGY ACC.DATE ACC.FILE NO.
ELECTRICAL BUILDING ENERGY,
FRAMING ELECT:FINAL TEST
INSULATION PLUMBING I 8Cf
ZONING ENG.SITE NO.
GAS TEST Z. ree
GAS
- MECHANICAL ,�f�-G�• FIRE SPRINK ' ENERGY T-}J
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING -Y "E Y ❑ No
,
EXTERIOR SHEAR ELECTRICAL RELEASE FLOOD)ONL AL C.
INTERIOR SHEAR --7, 00&b FIRE DEPT. Y ❑ No 0 No
SHEETROCK _ GRADE FEESUMMARY
EXTERIOR 'LATH - BUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDING 972.00
SCRATCH COAT. ELECTRIC - - PLAN CHECK 15.50
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE
OCCUPANCYOF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRIC 73.13
F—, ONE ONE WORKING,-DAY BEFORE REQUIRED INSPECTION. PLUMBING 73.13
OPLEASE GIVE JOB ADDRESS WHEN PHONING.
Z• MECHANICAL
• — SEE PERMIT FOR EXPIRATION DATE ,- '73 1
IMPORTANT! CONST.TAX 288.Y4
PLEASE READ REVERSE SIDE BEFORE,. TOTAL 570.78
CALLING FOR FINAL INSPECTION.
11 OFFICE COPY
-
FYr'PLICANT TO FILL IN INFORMATION WITHIN REDLINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION T t PERMIT NUMBER
jo,LD,NG A1�PL' r ATION & PERMIT ^
ADDRESS 562 even prangs `,
Lot 139 Plan 4A BUILDING -ELECTRICALS PLUMAING-MECHANICAL C
t ' NAMFRS ME �� I�,.,,,� PLAN CHECK VALIDATION
"Devel V' ^Wr I AI5-5�son DTV. ELECTRIC PERMIT FEE
CONTRACTOR'S
P
NAME UTLETS-SWITCHES-RECEP 10.00/1.00
a Gregory Group, INc• L,C.A.B�q 4M7 LIGHTING FIXTURES 10.00/1.00
DoHs
ADDRESS 220-0 Twin Dolphin Dr. M PPLIANCES-RESIDENTIAL 4.00
ADDRESS
CA 94065 415-&%m2100 PANELS 10.00 DATE OF APPLI CATION
ARCHITECT - PLAN CHECK PEE P.C.NO,
OR Aram Bassenian, AIA & PANELS (OVER 200 AMP) 20.00
ENGINEERASsociateSLIL.NO.
C-8395 SIGNS TRANS. 3.00
ARCH.OR ENG2031 0(rhard PERMIT VALIDATION
ADORESq hia �, C.A. 92707 SPECIAL CIRCUIT 5.00
�fCJDa1rl�11}A� i,P EMP.METER OR POLE INS. 20.00 n
APPLICANT's220 C win Dolphin Dr. RX MOTORS SEE FEE SCH. L:0"l.v-r te
ADDRESS 94065
SERVICE CHANGE 20.00 r (_y/,�
0 0 LICENSED CONTRACTORS DECLARATION YC
Q= I he¢by affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
Ps a a% femnmencing with Secliun 7000)of Division 3 ofthe Business and BLDG. ELECT. PLG. MECH.
H a z Professions Code,and ny license is in full force and effect i 1
z o m - License Clas_11_Lic.Number 7 IL'✓yl`
O m F Date Contracmr
a r BUILDING PERMIT
w a OWNER-BUILDER DECLARA ON
u INFORMATION
X
a w I hereby affirm that I ant exempt from the Contract.,',License MISC.- REFER TO ORD
F u W
Law g w for the following reason.(Sec.7031.5,Busituv and Professions VALUATION S/FT.
Code'.Any city or county which requires a permit to Construct,alter, PERMIT ISSUANCE 10 195 OOO
rt2 ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.NO. ELEC. )
u wO LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
r x r
Law(Chapter 9 fcommencingwilh Section 7000)of Ccry Division 3 ofthe SFW
a Business and Prufesstons Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE Anno
F $ the basis for the alleged exemption.Any violation of Section 7031.5 IES TYPE CONSTR,
a ; by any more
lore permit subjects $5000.licanlm a civil penalty ALTER-DRAIN St VENT-WATER 2 [�R
of not mart than five hundred dollars the applicant
p li
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00
their sole compensetksn,will Jo the work,and the structure is not OUP RES.UNITS
intended or offered for sale (Sec. 7144, Business and Professions DRAINS-FLOOR,ROOF,AREA.COND. 5.00 R-3 1
Code:The Contmemh License Law Jos not apply to an owner of
" 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
properly who builds or Improve thereon,and who lows Yoch work FIXTURES-PER TRAP
himself re through his own fiend for S provide) ev such improve-
ments
mprove- ,
mmselfe through dad oroffendemployees,
sale.If,howveruthe building GAS-EA.SYSTEM-1INC.4OUTLETS 6.00 2445
or improvement is soN within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00
builder will have the burden of proving that he did not build or im- BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Other
❑ I,as Owner at the property.am exClusivCly cmllracting with _
licensed contractors 10 construe the pieced(Beau does Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESS RSPARCEL NO.
El El El El El
and professionsneof Calc:The Contractor's i improv Law does not apply
to tr owner of property who builds t r improves thereon,and who LAWN SPRINKLERS-OVER 5 IEA.) 1.00 '
contracts for such projects with a coninetorts)licensed purwam to `
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 - TRACT No. PARCEL NO.
❑ lam exempt under Sec.-,BAP.C.lot this
Ra%m WATER HEATERW/VENT 6.00 8067
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE N0.
WORK ERS'COMPE:NSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent m sel Ginsure.
or a certificate of Workers'Compensation Insurance,or a cerlifted ZONING ENG,SITE NO.
Copy mcieof(SeC.3800.Lab.C.).United Pacific
Policy No. Company
O ❑ Citified'.p1rjIJic1gyfurnished' FIRE SPRINK ENERGYTYa
Z Z ❑ Certified wish the city inspection division.
O_ Applicant - MISC.- REFER TO ORD. Y N Y ❑ IN
CC tw CERTIFICATE 01'EXF.MPI'[ON FROM WORKERS' PERMIT ISSUANCE 10.D0 FLOOD ZONE A.L.u.c:
EL COAIPISNSAIIDN INSURANCE PLO.CONTE. LIC.NO. I.G.PYE] N� Y I NO
EL O ('This section need nal he comp leted�if the p.nuil is for one TOTAL
Z bended Jollarslf 1001 or lass.)
U O I.cerlily that in the performance of the work for which this per- QTY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is ismcd.I shall not employ any person in any manner so as to
U become subject to the Workers:Compensalion Laws of California.
O w Date-Applicant BUILDING
} y NOTICE TO APPLICANT': If,after-making this Ccrlifiealc of
Ex-emption,you should become subject m the Workers'Compensation APPLIANCE 5.00 PLAN CHECK 15.50
provisions of the Labor Code, you must forthwith Comply with FEE
U such provisions or this permit shall be dee nmd revokeiL AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
energ�_ 62-no
CONs'f RUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,ODOC.F.M.) 6.00 SEISMIC FEE 13.65
I hereby,affimt that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) _ 5.00
the performance afor hick W permit is Issued(SCo, MICROFILM
3097,Civ,C.). y dC1T 1C HEATING UNIT (TO 100,0DO B.T.U.) 8.00
Lender's NameHEATING UNIT(OVER 100,000 B.T.U.)Lender's Address _ 001' _ ELECTRIC 73.13
1 Certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information n correct I agree to comply with all city and county PLUMBING 73.l3
1 infinanen and sate laws relating m building l city ani co andmy BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this City m c',,let upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above menhuncd pro party for inspection purposes. 73.13
.J Cii agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against Utilities,judgments. Costs and Capenses which
ay In any way accrue against said City in Consequence of the PERMIT ISSUANCE 10.00 CONST.TAX 288,'Z4
rantingO(t f ��7 MECH.CONT.' LIC.NO. MECH. 1570.78 -
TOTAL TOTAL
%Signator pplicant/Contractor Di -
OFFICE COPY
1, CERTIFICATEOF COMPLETION
�j BUILDING INSPECTOR'S OFFICE
y/ CITY OF CUPERTINO
DATE / f 19 ff BLDG. PERMIT NO. q V /q
THE BLDG, LOCATED AT
��
OWNED BY 94 r D!a
• ' ,HAS BEEN (ALTERED) FOR USE AS
�i
Oy
r
Ii
BUILDING INSPECTOR
r